title: Assessment of fine-needle aspiration sampling technique in thyroid nodules.
abstract: BACKGROUND
  A prospective two-yr study was undertaken to assess the heterogeneity of thyroid nodules using the fine-needle aspiration (FNA) technique of systematic regional sampling. In addition, we determined the number of regions to be sampled to minimize non-diagnostic results, and to optimally characterize thyroid nodules.
  
  
  METHODS
  FNA was performed on 74 nodules > or = 1.5 cm. in diameter in five distinct regions in sequence (center, then four quadrants starting at 12:00, clockwise). Slides from each region were coded, randomized, subjected to blind review, and categorized as non-diagnostic (ND), benign (B), indeterminate (ID), suspicious/neoplastic (S/N), or malignant (M). Final cytologic diagnosis (CD) was made from all slides of each nodule.
  
  
  RESULTS
  The ND rate for center FNAs alone was 16%, but addition of the 12:00 region decreased it to 5.3%. With 3, 4, or 5 sequential sites the nondiagnostic rates were 4, 2.6, and 2.6%. The center region diagnosis was identical to the final CD in 71% of the cases. Addition of the 12:00 region increased the concordance to 88%. Three sequential regions equaled the CD in 93% of cases, and 4 regions equaled the CD in 99% of cases. All nodules characterized as M or S/N were resected as were 76% of the ID nodules. Of the 43 nodules characterized as B, 3 were resected, 24 involuted, 6 were unchanged, and 10 were lost to follow-up. All 3 M nodules proved malignant by histology, as did 7/10 S/N, 0/17 ID, and 0/43 B nodules; 3/10 S/N, 1/17 ID and 1/43 B were adenomas. Likelihood ratios for diagnosing neoplasia were ND:0, B:0.10, ID:0.21, S/N:infinity, M:infinity.
  
  
  CONCLUSIONS
  Sampling of at least four distinct regions accurately assesses thyroid nodules while minimizing ND results. Regional sampling also addresses intranodular heterogeneity.
authors.affiliation: Department of Pathology and Laboratory Medicine, Markey Cancer Center, University of Kentucky, Lexington 40536-0084, USA.
authors.forename: Y M
authors.initials: YM
authors.lastname: Musgrave
authors.forename: D D
authors.initials: DD
authors.lastname: Davey
authors.forename: J A
authors.initials: JA
authors.lastname: Weeks
authors.forename: E R
authors.initials: ER
authors.lastname: Banks
authors.forename: M K
authors.initials: MK
authors.lastname: Rayens
authors.forename: K B
authors.initials: KB
authors.lastname: Ain
mesh_terms: D001707:Biopsy, Needle; D005069:Evaluation Studies as Topic; D006801:Humans; D016013:Likelihood Functions; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016606:Thyroid Nodule / Q000473:pathology*